8. lecture-dentistry-Oral surgery_ENG.pptx

8th oral surgery lecture for students of dental medicine

1. INFECTIONS OF DENTOGENIC ETIOLOGY – II   FOSSA PTERYGOPALATINA This space is limited: cranially: it communicates via fosse orbitalis inferior with the contents of the orbit; medially: by the outer surface of the laminae perpendicularis ossis palatini ; laterally: it communicates with the fossa infratemporalis ; anteriorly: by the facies infratemporalisom maxillae. The content of this fossa is the n. maxillaris and the arteria maxillaris .

2. SPATIUM PARAPHARYNGICUM Purulent processes and infections of this area are closely related to diseases of the pharynx, throat, nose and ear, and these purulent processes are among the most dangerous. This space is limited:

3. cranially: by the skull base; inferiorly: by the lobus glandulae submandibularis ; medially: by the m. constrictor pharyngis ; laterally: glandulae parotis and the m. pterygoideus medialis .

4. This space communicates with the regio parotidea , fossa submandibularis , as well as the spatium retropharyngicum and the fossa temporalis. Because of this communication, the infection of this space can occur by spreading from the neighboring spaces, with which it communicates.

5. The content of this space consists of: arteria carotis interna , v. jugularis interna , n. glossopharyngeus , n. vagus , n. accessorius , n. hypoglossus and truncus sympathicus . Because of this content, this space is of vital importance.

6. SPATIUM RETROPHARYNGICUM This space is located at the back of the pharynx and is limited as follows: cranially: extends to the base of the skull; inferiorly: extends along the pharynx and esophagus ; anteriorly: m. constrictor pharyngis ; posteriorly: fascia prevertebralis ;

7. laterally: it communicates with the spatium parapharyngicum , and medially it is divided into two parts by a septum, only in the upper retro-nasal part, while this division does not exist in the lower part. The clinical importance of this space is that the infection of the adjacent spaces can spread into this space, and then it spreads most easily into the posterior mediastinum, which represents a fatal complication.

8. REGIO PAROTIDEA It is essentially a retromandibular space that is limited: cranially: by the external auditory canal; inferiorly: its bottom is the posterior arm of the m. digastrici; anteriorly: by the ascending branch of the lower jaw; posteriorly: by the mastoid extension of the os temporale and the m. sternocleidomastoideus .

9. This space is completely filled with the parotid gland, which is surrounded by a solid fascia that has several openings through which communication with the spatium parapharyngicum is established.

10. FOSSA INFRATEMPORALIS It is located between the processus pterygoidei ossis sphenoidalis and squamae ossis temporalis: cranially: communicates in the fossa temporalis; anteriorly and medially: opens into the fossa pterygopalatina ; laterally: ramus mandibulae inner side of pterygoideus internus; inferiorly: communicates with the spatium pterygomandibularis .

11. The content of this fossa consists of: a. and v. maxillaris , n. mandibularis , n. mylohyoideus and n. lingual.

12. FOSSA TEMPORALIS It is limited on the bone cranially by the linea temporalis, and inferiorly by the linea infratemporalis in two parts: planum temporale and planum infratemporale . It is limited anteriorly by the posterior edge of the cheekbone. Downwards it communicates with the fossa infratemporalis . This fossa is almost completely filled with the m. temporalis. From this fossa, the path to the inflammatory process is opened in the cranial direction.

13. INFECTION OF THE BASE OF THE UPPER LIP These infections are very dangerous because of the possibility of spreading to the infraorbital and periorbital area. Thrombosis of the sinuses can occur by the spread of infection from the plexus venosus of the upper lip via the v. angularis and c. ophthalmicae .

14. MAXILLARY SINUS INFECTION The pathology of the maxillary sinuses is an indispensable area for practicing dentists, oral and maxillofacial surgeons, and otorhinolaryngologists . It is very difficult to distinguish a maxillary sinus infection of dentogenic from non- dentogenic etiology .

15. Etiology Maxillary sinus infection can occur from the spread of infection from any maxillary premolar or molar. Usually, the infection can spread through the blood postoperatively after the extraction of upper lateral teeth, and especially after oroantral communication or pushing the root into the sinus.

16. Clinical picture and symptomatology The most pronounced symptoms are headache or pain in the sinus area. As the process progresses and the sinus fills with purulent contents, the sinus contents may be exposed to the nose with a characteristic odour. This smell is usually compared by patients to the smell of fermented cabbage.

17. Diagnosis and therapy The diagnosis is made on the basis of clinical examination, medical history and x-ray of the paranasal sinuses. The X-ray will show a shadowing, that is, reduced transparency of the sinuses. The main signs of an open sinus with closed nostrils is hissing air with blood through the extraction wound - Valsalva test. When rinsing the mouth with water, the patient will complain of water passing through the nose.

18. If the dentist did not make a diagnosis right after the extraction, later on during the check-up the patient will complain of pain, a characteristic smell that comes from decaying food, the wound does not heal and smoking patients complain that they feel like the cigarette is punctured when smoking, the so-called “punctured cigarette phenomenon”.

19. In therapy, the dentist must immediately prescribe antibiotics and adequately care for the extraction wound. If the extraction wound is narrow and deep, and the communication is small, then the prognosis is good and spontaneous closure of the communication can be expected.

20. The dentist should apply any of the Gelaspon gelfoam sponges to the apical third of the alveolar cup, provoke bleeding until the alveolus is filled with blood coagulum, and apply and fix iodoform gauze over the alveolus. Iodoform gauze is fixed with a ligature for adjacent teeth.

21. If there are no adjacent teeth, the gauze is fixed with a surgical suture. It is necessary to monitor healing through control examinations and refer the patient to a diet and hygiene regimen. However, if the alveolus is shallow, the communication with the sinus is wide, the prognosis is poor in terms of spontaneous closure of the communication.

22. In this case, the dentist should tamponade the wound with iodoform gauze, prescribe antibiotics and refer the patient to an oral surgeon, who will close the oroantral communication with a special operative procedure.